Localization and therapy of non-prostatic endocrine cancer with agents directed against prostate specific antigen

ABSTRACT

It was discovered that prostate-specific antigen is produced by non-prostatic endocrine cancers. It was further discovered that non-prostatic endocrine cancers with steroid receptors can be stimulated with steroids to cause them to produce PSA either initially or at increased levels. This invention relates to the imaging of non-prostatic endocrine cancers by labelled biological binding units which bind to prostate-specific antigen in an imaging procedure, such as, radio imaging or magnetic resonance imaging. Further, the PSA-binding units may be constructed to deliver a toxic agent, such as a radioisotope, toxin or a drug to provide endocrine cancer therapy. Another aspect of the invention is passive immunotherapy against endocrine cancers by treatment with PSA-binding units.

This application is a divisional of U.S. Ser. No. 08/569,206, filed Apr. 11, 1996, now U.S. Pat. No. 6,068,830, which is a 371 of PCT/CA94/00392, filed Jul. 14, 1994, and claims the benefit of GB 93 14623.1, filed Jul. 14, 1993.

FIELD OF THE INVENTION

This invention relates to the localization and therapy of non-prostatic endocrine cancers by agents that have been constructed to target prostate specific antigen (PSA).

BACKGROUND OF THE INVENTION

Cancer of the breast is the most common cause of cancer death in middle aged women in Europe and North America and both its incidence and mortality are on the increase (1-5). The predominant indications for breast tumor imaging are: detecting the presence of tumor, localizing sites of disease, and following the effects of therapy (6). Trends in scintigraphic imaging have been towards developing imaging pharmaceuticals to provide quantitative information on the pathophysiological characteristics of a tumor, such as its anaplasticity, or likely response to a given therapy (7). For example, to determine via scintigraphic imaging how a patients breast cancer will respond to the administration of a growth suppressor, such as somatostatin, or the estrogen receptor antagonist tamoxifen (8 Diamandis in PCT Application CA 94/00267 has shown that the presence of PSA in breast tumors, as measured by in vitro methods, has prognostic value. Thus, imaging of these tumors may not only reveal occult disease, but may also provide clinically valuable pathophysiological information.

Tumor imaging is commonly carried out using a gamma emitting radionuclide conjugate and a scintillation gamma camera, or with a positron emitting radiopharmaceutical and a positron or PET camera, or with a magneto-pharmaceutical and a magnetic resonance imaging device. The scintillation camera, also known as an Anger camera, consists of a detector head, and a display console. The Anger camera head is composed of sodium iodide crystals that absorb gamma rays and emits the absorbed energy as flashes of light—scintillations that are proportional in brightness to the energy absorbed. In a gamma camera the sodium iodide crystals are coupled to photomultiplier tubes that convert light pulses into electronic pulses. These voltages are translated via a computing circuit to a cathode ray tube. The data from the camera head may be in either analog or digital form that can be stored in a computer and can reconstruct the data to provide an image. Single-photon emission computed tomography (SPECT) imaging involves the use of a gamma scintillation camera where multiple images, typically encompassing 180° or 360°, around the body are taken and the computer issued to reconstruct multiple tomograms in coronal, sagittal, and transverse projections. In PET imaging the positron radionuclide collides with an electron causing annihilation of the particles and creating two photons that travel in 180° opposite directions. The PET system is designed to capture opposite sides and register the count at precisely the same time. A computer is used to manipulate the data and then reconstruct a cross sectional image from this information.

There are a number of approaches to breast tumor imaging that may be divided into two groups: indirect and direct. Indirect techniques, are generally utilized to locate metastatic disease by recognizing the secondary effects of tumor within an organ system. Indirect techniques include, but are not limited to, the use of radiolabelled ^(99m)Tc phosphonates to locate bone metastases (9,10) and ^(99m)Tc radiocolloids in liver scans and breast lyphoscintigraphy (11,12,13).

Direct approaches to radionuclide imaging include radiolabelled chemotherapeutic agents, simple ionic substances, metabolite imaging, immunologic and receptor imaging. The use of radiolabelled chemotherapeutic agents, such as bleomycin, have not demonstrated clinical value (14). ⁶⁷Ga citrate is the most commonly used simple ionic tracer for tumor imaging, however it localizes in other pathologies and is non specific (15,16,17,18). Metabolite imaging carried out with positron emitting radionuclides such as ¹⁸F-fluorodeoxyglucose, ¹¹C-methionine and ¹¹C-thymidine provides tumor metabolism information that has been shown to be clinically valuable for disease staging (19,20,21).

The receptor imaging of breast cancer has been attempted by several approaches. Spicer et al. (22) and Hochberg (23) and others (24-29) have developed radiolabelled estradiols and have been able to demonstrate imaging in estrogen receptor positive breast cancers. It has been postulated that a therapeutic response could result with Auger electrons from ¹²³I or ¹²⁵I radiolabelled estradiols(30,31), or from β emitting radioisotopes such as ¹⁸⁶Re conjugated to progesterone (32). A problem with receptor based imaging is the interference that estrogen receptor antagonists, such as tamoxifen, may have in the clinical environment.

It is known that proteins, such as antibodies, can be developed against specific antigens that are either produced or associated with tumors, can be used to localize tumors. U.S. Pat. No. 3,927,193 to Hansen et al. (33) discloses a process whereby antibodies to carcinoembryonic antigen (CEA) and labelled with ¹²⁵I and ¹³¹I were used to image the location of tumors present in hamsters. From this work it was proposed that the location of a tumor in a human could be determined by in vivo administration of a parenteral solution containing an antibody-radioisotope conjugate followed by imaging by a gamma camera. Goldenberg et al. reported success in clinical trials of tumor detection and localization by scintillation scanning of patients that received radiolabelled antibodies to CEA (34).

Based on the original work of Milstein and Kohler (35), monoclonal antibodies have been developed against a variety of tumour antigens such as CA 19.9, CA 125, melanoma associated antigens, TAG 72, ∝ fetal protein, ferritin, choriogonadotropin, prostatic acid phosphatase, and PSA for radioimmunoimaging and therapy.

Several investigators have reported on the development of monoclonal antibodies against epitopes of various malignant prostate cell components (36,37,38,39,40). Moreover, PSA was purified and well characterized and found to have a molecular weight in the range of 34,000 (41). PSA is used widely as a tumor marker for in vitro based analyses for diagnostic and monitoring purposes of prostatic carcinoma. U.S. Pat. No. 5,162,504 describes monoclonal antibodies that have been developed to recognize malignant prostate epithelium. These antibodies were developed as diagnostic and prognostic tools for the detection of cancer of the prostate, not as embodied in this invention, for the detection of cancers not associated with the prostate. Until the discovery reported by Diamandis in International Application PCT CA94/00267, it was thought that PSA only occurred in men and was only produced by prostate tissue.

To image breast tumors researchers have developed antibodies directed against TAG 72, CA-3, CEA, EGF-R, LASA-P, and other glycoproteins associated with breast cancer (42,43,44). Khaw et al. developed the monoclonal antibody 323/A3 against a 43 Kd membrane associated glycoprotein from the MCF-7 tumor cell line that was able to image tumors as small as 0.19 grams (45). Rainsbury et al. developed the antibody LICRCON-M8 against human milk fat globule and were also able to demonstrate imaging of human breast tumors, of particular note metastases to the bone were found (46).

Antibodies have been labelled directly with radioisotopes such as ¹²³I, ¹²⁵I, ¹³¹I, ¹⁸F, ¹⁸⁶Re, ¹⁸⁸Re, and ^(99m)Tc and indirectly with chelating complexes such as diaminetrimethylenepentaacetic acid using ¹¹¹In, ⁹⁰Y, ^(99m)Tc, ¹⁸⁶Re and ¹⁸⁸Re (47,48). Antibody-mediated radiotherapy may be carried out using either beta emitting radionuclides such as ¹⁸⁶Re, ¹⁸⁸Re, ¹³¹I, ⁹⁰Y, ¹⁵³Sm, ³²P or ¹⁰⁹Pd, or with alpha particle emitters such as ²¹¹At or ²¹²Pb, or with Auger electron emitters such as ¹²⁵I or ¹²³I (47,48). Therapy may also be attempted with either drug or toxin based conjugates for example Adriamycin-immunoconjugates (49) and vinblastine-immunoconjugates (50) have been developed. An unexpected finding of the clinical usefulness of immunoscintigraphy has been the reported complete remission of 7 out of 10 FIGO IV ovarian cancer patients who under went repeated imaging with an OC 125 antibody and had anti-idiotypic HAMA (51).

Magnetic resonance imaging can be carried out using gadolinium and other lanthanides or metals such as iron conjugated to antibody based proteins. Several versions of these antibody based products are believed to be undergoing clinical evaluation and commercial development presently.

To improve the specific activity and safety of the immunoconjugate directed towards tumor markers several approaches have been taken ranging from the use of antibody fragments to genetic engineering of recombinant produced humanized antibody constructs to synthetic peptides based on the antibody epitope (52,53). Methods of antibody engineering including single chain antibodies have been well summarized by Borrebaeck (54). These improvements have improved the tumor target to background ratio and reduced the incidence of human antimouse antibody response.

The present invention provides a method for detecting, locating and treating non-prostatic endocrine tumors involving PSA as the tumor marker and optionally further optionally improves this method by first priming the endocrine tumors to produce PSA.

SUMMARY OF THE INVENTION

According to aspects of the invention, a method for detecting and locating non-prostatic endocrine cancers in vivo by injecting the human subject parenterally with an entity that has been constructed to target PSA, that is either a polyclonal or monoclonal antibody, or fragments thereof, or constructs thereof including but not limited to, single chain antibodies, bifunctional antibodies, molecular recognition units, and peptides or entities that mimic peptides, where the tumor targeting agent is labelled either directly, or indirectly with a chelating agent, with one of ¹³¹I, ¹²⁵I, ¹²³I, ¹¹¹In, ^(99m)Tc, ⁹⁰Y, ¹⁸⁶Re, ¹⁸⁸Re, ³²P, ¹⁵³Sm, ⁶⁷Ga, ²⁰¹Tl, ⁷⁷Br or ¹⁸F and is imaged with a photoscanning device, or where the tumor targeting agent is labelled with either gadolinium, terbium, tin, iron, or isotopes thereof and attached covalently to create a paramagnetic conjugate for the purpose of magnetic resonance imaging.

According to a further aspect of the invention, an in vivo method for imaging endocrine cancer in non-prostatic tissue of a patient comprises:

injecting a patient with biological binding units which bind to PSA produced by non-prostatic tissue of the patient, said PSA-binding units being labelled with imaging agents;

allowing said binding units to incubate in vivo and bind PSA associated with the endocrine cancer; and

detecting presence of said imaging agents of bound units localized to said endocrine cancer.

According to another aspect of the invention, a method for detecting and locating endocrine cancers as described above, wherein the human subject is first given a steroid which induces the cancer cells to express the PSA gene.

Such method further comprises the initial step of injecting a patient with a steroid which induces the cancer cells to produce PSA, said cancer cells having receptors for the injected steroid.

According to another aspect of the invention, a method where entities constructed to target PSA as described above deliver a toxic agent which is a radioisotope that emits Auger electrons, and/or other sub-atomic particles, or toxic compounds including, but not limited to, diphtheria toxin, ricin toxin, adriamycin, chlorambucil, or daunorubicin.

According to another aspect of the invention, a method of passive immunotherapy to endocrine cancer where PSA antibodies, or constructs thereof including, but not limited to, chimeric or human antibodies, or their fragments, single chain antibodies, molecular recognition units, and peptides or entities that mimic peptides are administered parenterally.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is high performance liquid chromatography (HPLC) with a gel filtration column. Each HPLC fraction (0.5 mL) was analyzed with an assay that measures free and a₁-antichymotrypain-bound PSA (ACT-PSA) () or an assay that measures only ACT-PSA (♦). The response of the latter assay is in arbitrary fluorescence units since no ACT-PSA standard exists. A. Injection of purified seminal PSA which elutes at fraction 39 corresponding to a molecular weight of 33 kDa. No ACT-PSA is detected. B. Injection of a breast extract from the woman receiving the oral contraceptive Brevicon®. The PSA assay detects two peaks, one at fraction 39 (free PSA, major peak) and one at fraction 30 (100 kDa, minor peak). The latter peak is ACT-PSA as confirmed by the ACT-PSA assay. The identity of the minor peak at fraction 21 (650 kDa) is unknown. This data confirms that over 80% of the breast tissue PSA is in the free, 33 kDa form. The HPLC column was calibrated with molecular weight standards eluting at fraction 21 (660 kDa); 28 (160 kDa); 37 (44 kDa); 42 (17 kDa) and 49 (1.4 kDa).

FIG. 2 is a Western blot analysis. Samples were electrophoresed on 8 to 16% gradient polyacrylamide minigels under reducing conditions, electrotransferred to nitrocellulose membranes and probed with a rabbit polyclonal anti-PSA antibody. Detection was achieved by using a horseradish peroxidase-conjugated goat anti-rabbit antibody and chemiluminescence. Lane 1. Molecular weight markers. Lane 2. Purified seminal PSA dissolved in bovine serum albumin. The PSA band appears at 33 koa (just above the 31 kDa marker). Lane 3. Supernatant from a prostatic carcinoma cell line (LNCaP) producing PSA. Lane 4. PSA-positive normal breast extract from the woman receiving Brevicon, containing a band at 33 kDa. Lane 5. Another normal breast extract tested negative for PSA by the immmunofluorometric procedure. Lane 6. An amniotic fluid tested for comparison.

FIG. 3 is production of PSA by the breast carcinoma call line MCF-7. Cells were grown to confluency and then stimulated with varying concentrations of either norethindrone (1) or ethinyl estradiol (2) at the final concentrations indicated, in the absence of fetal calf serum from the culture medium. PSA was measured in the culture supernatant 10 days post No PSA was detected in cell cultures grown identically but either non-stimulated or stimulated with the solvent alone (ethyl alcohol). Norethindrone stimulates PSA production at concentrations as low as 10⁻¹⁰ M.

FIG. 4 is the gamma camera image of a female SCID mouse the left leg of which was injected with norgestrel-stimulated T47-D human breast cancer cells. The image was obtained 21 hours after injection of 10 MBq technetium-99m-labelled B80 anti-PSA monoclonal antibody via the tail vein. The image is an anterior view with the head at the top and the left leg extended to the side.

FIG. 5 is the gamma camera image of a female SCID mouse the left leg of which was injected with non-stimulated T47-D human breast cancer cells. The image was obtained 21 hours after injection of 10 MBq technetium-99m-labelled B80 anti-PSA monoclonal antibody via the tail vein. The image is an anterior view with the head at the top and the left leg extended to the side.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

This invention originated with the surprising discovery that the presence of PSA in human female breast is indicative of breast tumour. PSA was never thought to exist in females because PSA has always been thought to be associated with the male prostate. This discovery and its use in the prognosis of female breast cancer is described in applicant's international application PCT CA94/00267 filed May 13, 1994.

From the discovery of PSA in breast tumors, we have now determined that cancer cells with steroid receptors can be stimulated to produce PSA. It was discovered that normal breast tissue cells and non-PSA producing breast tumor cell lines (our earlier British patent application S.N. 9401491.6 filed Jan. 26, 1994) could be stimulated to produce PSA. Furthermore, non-PSA producing ovarian tumor cells could also be stimulated to produce PSA. Hence, the existence of PSA in a localized region of the body is indicative of a cancer tumor. Procedures to then image the localized concentration of PSA are therefore very useful in cancer diagnosis and prognosis.

Prior to the present invention, agents developed to target PSA were used for diagnostic and therapeutic purposes for prostate cancer only. This invention now provides for the use of radioisotopic or non-isotopic elements containing immunoconjugates directed against PSA in tumours for targeting non-prostatic endocrine cancer In vivo. The procedure is also used for the localization and monitoring of metastases by either nuclear-based gamma camera or magnetic resonance imaging. Another advantage of the invention is the application of reagents directed against PSA labelled with a therapeutically effective radionuclide, drug or toxin for the purpose of therapeutic intervention of breast cancer.

Antibodies or chemical entities created to recognize PSA are used to carry elements to image PSA secreting cancer cells and locate the disease. These antibodies or chemical entities are included in the term biological binding unit, which term is used to refer to patient compatible entities which bond to PSA and comprise antibodies or their derivatives, molecular recognition units and peptides. Antibodies encompass monoclonal and polyclonal antibodies and their derivatives and fragments and include single chain antibodies, bifunctional antibodies and other antibody constructs. Further, these biological binding units may deliver particle emitting radionuclides, drugs or toxins to promote a therapeutic effect. For example, a peptide created to recognize PSA delivering ¹⁸⁸Re to the tumour site thereby delivers localized radiation to ablate the disease.

By way of a further example, a peptide may be developed that mimics the epitope for anti-PSA and binds to PSA and PSA receptors. This peptide may be produced on a commercially available synthesizer, using FMOC solid phase chemistry. In one application, either tyrosine, lysine, or phenylalanine is included in the peptide to which an N₂S₂ chelate is complexed as per U.S. Pat. No. 4,897,255. The anti-PSA peptide conjugate is then combined with a radiolabel, for example, either sodium ^(99m)Tc pertechnetate (Na^(99m)TcO₄) or sodium ¹⁸⁸Re perrhenate(Na¹⁸⁸ReO₄) and may be used to locate a PSA producing tumor.

The invention also provides the use of anti-PSA antibodies covalently combined with radioactive, cytotoxic or chemotherapeutic molecules and considers using these antibodies in immunoabsorption procedures to separate benign from malignant cells. Further, the concept of passive immunotherapy with antiidotypic antibodies is now possible.

This invention includes a method for detecting and locating non-prostatic endocrine cancers in vivo by injecting a human subject parenterally with an entity that has been constructed to target PSA, that is either a polyclonal or monoclonal antibody, or fragments thereof, or constructs thereof including, but not limited to, single chain antibodies, bifunctional antibodies, molecular recognition units, and peptides or entities that mimic peptides, where the tumour targeting agent is labelled either directly, or indirectly with a chelating agent, with one ¹³¹I, ¹²⁵I, ¹²³I, ¹¹¹In, ^(99m)Tc, ⁹⁰Y, ¹⁸⁸Re, ¹⁵³Sm, ⁶⁷Ga, ³²P, ²⁰¹Tl, ⁷⁷Br or ¹⁸F and is imaged with a photoscanning device, or where the tumour targeting agent is labelled with either gadolinium, terbium, tin, iron or isotopes thereof and attached covalently to create a paramagnetic conjugate for the purpose of magnetic resonance imaging. A further application of the radioimaging technique is in the field of radioimmunoguided surgery, whereby a hand-held scintigraphic probe detector enables a surgeon to identify and remove localized metastatic disease (60).

A list of radioisotopes which can be used in the above application is as follows: ²⁷⁷AC, ²¹¹At , ¹²⁸Ba, ¹³¹Ba, ⁷Be, ²⁰⁴Bi, ²⁰⁵Bi, ²⁰⁶Bi, ⁷⁶Br, ⁷⁷Br, ⁸²Br ¹⁰⁹Cd, ⁴⁷Ca, ¹¹C, ¹⁴C, ³⁶Cl, ⁴⁸Cr, ⁵¹Cr, ⁶²Cu, ⁶⁴Cu, ⁶⁷Cu, ¹⁶⁵Dy, ¹⁵⁵Eu, ¹⁸F, ¹⁵³Gd, ⁶⁶Ga, ⁶⁷Ga, ⁶⁸Ga, ⁷²Ga, ¹⁹⁸Au, ³H, ¹⁶⁶Ho, ¹¹¹In, ^(113m)In, ^(115m)In, ¹²³I, ¹²⁵I, ¹³¹I, ¹⁸⁹Ir, ^(191m)Ir, ¹⁹²Ir, ¹⁹⁴Ir, ⁵²Fe, ⁵⁵Fe, ⁵⁹Fe, ¹⁷⁷Lu, ¹⁵O, ^(191m-191)Os, ¹⁰⁹Pd, ³²P, ³³P, ⁴²K, ²²⁶Ra, ¹⁸⁶Re, ¹⁸⁸Re, ^(82m)Rb, ¹⁵³Sm, ⁴⁶Sc, ⁴⁷Sc, ⁷²Se, ⁷⁵Se, ¹⁰⁵Ag, ²²Na, ²⁴Na, ⁸⁹Sr, ³⁵S, ³⁸S, ¹⁷⁷Ta, ⁹⁶Tc, ^(99m)Tc, ²⁰¹Tl, ²⁰²Tl, ¹¹³Sn, ^(117m)Sn, ¹²¹Sn, ¹⁶⁶Yb, ¹⁶⁹Yb, ¹⁷⁵Yb, ⁸⁸Y, ⁹⁰Y, ⁶²Zn, ⁶⁵Zn.

These entities which are constructed to target PSA, as aforementioned, can also deliver a toxic agent for therapeutic purposes against breast cancer, where the toxic agent is a radioisotope that emits Auger electrons, and/or α particles, and/or β particles, and/or neutrons, and/or other sub-atomic particles, or toxic compounds including but not limited to, diphtheria toxin, ricin toxin, adriamycin, chlorambucil, or daunorubicin. Further toxins which can be used are ricin and its derivatives and fragments, Monensin, Verrucarin A, Abrin and its derivatives, Vinca alkaloids, Tricothecenes, and Pseudomonas exotoxin A. Further drugs for use as toxic agents are as follows: Leucovorin, Folinic acid, Methotrexate, Mitomycin C, Neocarzinostatin, Vinblastine, Mitomycin, Melphalan, Mechlorethamine, Fluorouracil, Fluoxuriding, Idarubicin, Doxorubicin, Epirubicin, Cisplatin, Carmustine, Cyclophosphamide, Bleomycin, Vincristine and Cytarabine.

A list of radioisotopes, which can be used for treating endocrine cancers, is as follows: ²⁷⁷Ac, ²¹¹At, ¹³¹Ba, ⁷⁷Br, ¹⁰⁹Cd, ⁵¹Cr, ⁶⁷Cu, ¹⁶⁵Dy, ¹⁵⁵Eu, ¹⁵³Gd, ¹⁹⁸Au, ¹⁶⁶Ho, ^(113m)In, ^(115m)In, ¹²³I, ¹²⁵I, ¹³¹I, ¹⁸⁹Ir, ^(191m)Ir, ¹⁹²Ir, ¹⁹⁴Ir, ⁵²Fe, ⁵⁵Fe, ⁵⁹Fe, ¹⁷⁷Lu, ¹⁰⁹Pd, ³²P, ²²⁶Ra, ¹⁸⁶Re, ¹⁸⁸Re, ¹⁵³Sm, ⁴⁶Sc, ⁴⁷Sc, ⁷²Se, ⁷⁵Se, ¹⁰⁵Ag, ⁸⁹Sr, ³⁵S, ¹⁷⁷Ta, ^(177m)Sn, ¹²¹Sn, ¹⁶⁶Yb, ¹⁶⁹Yb, ⁹⁰Y, ²¹²Bi, ¹¹⁹Sb, ¹⁹⁷Hg, ⁹⁷Ru, ¹⁰⁰Pd, ^(101m)Rh, ²¹²Pb.

Since PSA was found to be associated with more benign breast tumors, it was possible that PSA could be expressed by normal breasts either under physiological circumstances or after steroid hormone stimulation, such as described in the aforesaid British patent application. Cytosolic extracts were prepared as previously described (56) from eighteen normal breast tissues removed from nine women (left and right breast) during breast reduction surgery. PSA immunoreactivity was measured in these extracts using a highly specific and sensitive immunofluorometric technique (57) and by two widely used commercial PSA assays. Breast extracts from eight of the nine women were found to contain <0.03 ng of PSA per mg of total protein and were considered negative for PSA. Surprisingly, two breast extracts from the same woman (left and right breast) had relatively high concentrations of PSA (0.11 and 1.53 ng/mg). None of the eight PSA-negative women was receiving oral contraceptives or other medications. The woman with PSA-positive breasts was receiving only one medication, Brevicon®, a highly prescribed oral contraceptive containing 1 mg norethindrone (a progestin) and 0.035 mg ethinyl estradiol per tablet. The PSA-positive and negative results in the breast extracts by the immunofluorometric procedure were verified by using two widely used commercial PSA methods, namely, the IMx® from Abbott Labs, Abbott Park, Chicago, Ill. and the Tandem®-E kit from Hybritech Inc., San Diego, Calif. Additionally, one highly positive extract was serially diluted in female serum from 2- to 32-fold and analyzed by immunofluorometry and the IMx assay. Identical results were obtained.

The highly positive breast extract was also subjected to high performance liquid chromatography (FIG. 1) and fractions were analyzed by two immunofluorometric procedures which measure either total PSA (free PSA plus PSA bound to a₁-antichymotrypsin) or specifically the PSA-a₁-antichymotrypsin (ACT) complex (S). Over 80% of the total PSA in normal breast was in the free, 33 kDa form; a small proportion was present as PSA-ACT complex (100 kDa). Another minor species, containing PSA and ACT was also detected (660 kDa), but its identity is unknown. The presence of PSA in the highly positive breast tumor extract was further confirmed by Western blot analysis (FIG. 2). This 33 kDa form of PSA, present in normal breasts stimulated by oral contraceptives, is similar to the PSA form found in breast tumors (1). In male serum, the majority of PSA is present as PSA-ACT complex with a molecular weight of 100 kDa (57).

In order to study the oral contraceptive-induced PSA production further, T-47D and MCF-7 breast carcinoma cell lines were cultured in the absence of any steroid hormones or in the presence of norethindrone or ethinyl estradiol at various concentrations (FIG. 3). No PSA was detected in the tissue culture supernatants in the absence of steroid hormones after 11 days of confluent cultures. Ethinyl estradiol stimulated low levels of PSA production at concentrations ≧10⁻⁸ M. Norethindrone was effective in mediating intense PSA gene expression at concentrations as low as 10⁻¹⁰ M. Other progestins were also effective in mediating PSA gene expression. The identity of PSA in the. tissue culture supernatants was further characterized by HPLC and Western blot analysis as shown in FIGS. 1 and 2. Additionally, we were able to amplify by reverse transcription-polymerase chain reaction (RT-PCR), prostate specific antigen mRNA from the stimulated but not the non-stimulated cells and verify its identify by Southern hybridization and sequencing of the PCR product (58). The same procedures confirmed the presence of PSA in breast tumors positive for the protein.

We recently demonstrated that among 99 ovarian tumor extracts tested only three were positive for PSA and the concentration of the PSA was 0.048, 0.034 and 0.0076 ng/mg. Subsequently, a patient with ovarian cancer who also underwent liver transplantation and was receiving oral prednisone tablets during the period of ovarian tumor removal was tested for the presence of PSA in the ovarian tumor. Remarkably, this ovarian tumor contained 15 ng of PSA/mg protein, which is a very high amount. Combined with our previous results on breast tumor cell line tissue culture systems (British Patent Application S.N. 9401491.7) in which we found that glucocorticosteroids can stimulate PSA production, it is apparent that the ovarian tumor, generally unable to produce PSA, can be stimulated by steroids like prednisone, to produce very high levels of PSA in the tumor. The tumors, which may be imaged and treated in this invention, have steroid receptors which are stimulated in the presence of steroids to express the PSA gene and thus produce PSA. The PSA-binding units can then bind to cancer cells producing PSA which allows these cancers to be treated and localized.

Following this demonstration of stimulation of PSA gene expression in breast carcinoma cell lines and ovarian tumors, it is a further feature of the invention that stimulating cancers to express PSA would either enable detection of previously undetectable tumors or would improve radioimaging of previously detectable tumors. Indeed as shown with the normal breast tissue of the patient receiving the oral contr ceptive, steroid receptor positive tissues could be induced to produce PSA which would enable these tissues to be radioimaged. Further, the production of PSA by the non-PSA producing normal breast and ovarian tumor tissues after stimulation will enable radioimaging of non-PSA producing endocrine tumors after stimulation. While normal endocrine tissue can be stimulated to produce PSA, it will not be produced at the high levels produced by stimulated endocrine cancer cells. Thus, priming a patient with a steroid which induces PSA gene expression to, in turn, produce PSA at the tumor site, provides increased binding of the entity targeting PSA to endocrine tumors and improves the radioimaging or therapeutic delivery of toxic agents.

Gamma camera images of SCID mice with norgestrel-stimulated (FIG. 4) and non-stimulated (FIG. 5) T47-D human breast cancer cells injected into the muscle of the left leg were taken. Images were obtained 21 hours after injection of 10 MBq technetium-99m-labelled B80 anti-PSA monoclonal antibody via the tail vein. Images are anterior views, heat at top, with left leg, which contains the tumor cells, extended to the side and immobilized. An upper threshold of 5% was used to mask the residual radioactivity in the liver and the abdomen. (That is, the top 5% of counts were subtracted from all images to allow the leg tumor to be viewed.) The leg containing the tumor is seen in the lower right portion of each image. Quantification of this pair of digital images showed that the stimulated tumor contained at least 15% more radioactivity than the control tumor.

Tissue counting results were obtained for blood, normal muscle and either the stimulated or control T47-D tumor and are provided in Table 1. All values are percent injected dose per gram tissue, expressed as a mean±standard deviation for 4 animals or individual values for 2 animals. Table 1 demonstrates that the T47-D tumor cells had at least double the counts of the control. Furthermore, the stimulated tumor cells have increased counts over that of the non-stimulated tumor cells. Thus radioimaging was improved by stimulation to increase PSA production.

TABLE 1 Blood 0.96 ± 0.14 Normal muscle 0.129 ± 0.029 T47-D control tumor 0.228 − 0.231 (range 2 animals) T47D- stimulated tumor 0.266 − 0.405 (range 2 animals)

It was proven that the norgestrel-stimulated T-47D cells in the above experiment were producing PSA from the detection of PSA in the cell culture supernatant. Furthermore, T-47D and MCF-7 tumor cell lines were injected into SCID mice to develop tumors, which mice were then injected with estrogen and/or norgestrel. The results (Table 3) demonstrated that human PSA was found in the serum of mice injected with norgestrel, however, estrogen blocked the effect of the norgestrel. Estrogen was previously shown to block the effect of progestin on PSA production in the tumor cell lines tested in our earlier British patent application S.N. 9401491.7

The breast tumor cell line tissue culture system (described in British patent application S.N. 9401491.7) suggested that any steroid having either glucocorticoid, mineralocorticoid, antiestrogen, progestin or androgen activity can regulate the PSA gene; however, estrogens cannot mediate such action. These results combined with the results from steroid stimulation of PSA expression in normal breast cells and non-PSA producing breast tumor cell lines and ovarian tumor, indicate that to stimulate tumors for radioimaging applications, any natural or synthetic steroid falling under the above categories of activity would be suitable. A list of steroids to induce expression of the PSA gene is found in Table 2.

A list of non-prostatic endocrine tumors which can be stimulated to express the PSA gene either initially or to increase PSA expression is as follows: breast tumors, ovarian tumors, lung carcinomas, meningiomas, endometrial carcinomas, colon carcinomas, salivary gland tumors, cervical carcinomas, uterine carcinomas, adrenal tumors, renal carcinomas and melanomas. The steroids, which stimulate the production of PSA, may be naturally present in the body or may be introduced artificially by injection.

An alternative aspect of this invention, as it relates to in vivo antibody binding, is a method of passive immunotherapy to non-prostatic endocrine cancer where PSA antibodies, or constructs thereof including, but not limited to, chimeric or human antibodies, or their fragments, single chain antibodies, molecular recognition units, and peptides or entities that mimic peptides are administered parenterally. Antiidiotypic antibodies may then be produced in reaction to this administration.

Antiidiotypic antibodies are antibodies directed against the idiotype (the antigen combining region or variable region) of another antibody, in this case anti-PSA antibody. These antiidiotypic antibodies in turn stimulate the production of antibodies against the idiotype of the antiidiotypic antibodies. Thus this sub-population of antiidiotypic antibodies bind the initial antigen, PSA. For example, human anti-PSA antibodies can be administered to patients that have PSA secreting breast tumors. A dose escalating regime can be followed, over a period of months, if there is an absence of any untoward response. Patient sera can be examined via in vitro methods for the development of antiidiotypic antibodies. The development of anti-idiotypic antibodies results in enhancement or beneficial modification of the patient's immune response and thereby elicits an anti-tumor response (51).

EXAMPLE 1

Breast tumors were snap-frozen in liquid nitrogen. Frozen sections (5 μm thick) were placed on clean glass slides and processed for immunohistochemistry. Slides to be stained for PSA were fixed immediately in 10% buffered formalin for 10 min. and then placed in phosphate-buffered saline. Staining was performed with a polyclonal anti-PSA antibody from Medix Biotech, Foster City, Calif. and further completed by use of the avidin-biotin technique (ABC) using a kit from Vector Laboratories, Burlingame, Calif. Immunoperoxidase staining was, according to the manufacturer's recommendation (58). Tumors positive or negative for PSA by the immunof luorometric procedure were used. The slides were examined under a light microscope. Tumors, negative for PSA showed no staining while tumors positive for PSA exhibited strong brown cytoplasmic staining with the immunoperoxidase technique. This experiment demonstrated that PSA in breast tumors can be localized by antibodies against PSA.

EXAMPLE 2

Cell Preparation

The following cell line was obtained from the ATCC: T47-D, an estrogen dependent cell line derived from breast cancer. The cell line was checked for freedom from microbial contaminants and all operations were carried out aseptically. T47-D cells were cultured in α Medium with 10% fetal calf serum in sterile culture flasks. Cells were then incubated at 37° C. and growth was checked visually using a microscope. Two sets of T47-D cells were prepared, one set stimulated with norgestrel, a progestin, and the other set non-stimulated. The stimulated set were stimulated with a solution of norgestrel (concentration 1 millimole in ethanol), at the concentration of 1 micromolar in fresh media for a period of 48 h. PSA was detected in the supernatant of the norgestrel-stimulated cells' supernatant after 72 h and the concentration of PSA increased from 0.013 μg/L to 0.036 μg/L at 96 h.

Cells were scraped into a centrifuge tube and spun down in a laboratory centrifuge at approximately 240 G for six minutes. Cells were re-suspended using the sterile culture medium and re-spun, the procedure was repeated a total of three times. For a 0.2 ml pellet of cells, 0.1 ml was injected subcutaneously into the left leg, slightly below the knee, in female SCID mice. The amount of cells injected into the SCID mice were estimated to be between 2.5×10⁶ and 1×10⁷. The experiment was repeated once using trypsin to avoid clumping of the harvested cells, in which case the stimulation with norgestrel was increased to 2 micromolar in fresh culture medium to overcome any effect due to trypsin. The results of imaging shown in FIG. 4 and 5 were obtained using cells harvested by scraping, whereas the results of Table 1 were obtained using cells harvested with trypsin.

Preparation of the Monoclonal Antibody

The anti-PSA monoclonal antibody, B 80, was obtained from Biomira Inc., Edmonton, Alberta. The antibody was prepared for radioimaging using the method described by Joiris et al. (55) with 2 iminothiolane. Three solutions are first prepared: 5 milligram/ml solution of B 80 in physiological saline; 10 milligram/ml solution of 2 iminothiolane; and a phosphate buffer solution containing 0.25M of phosphate adjusted to pH 7.4. 10 microliters of each of these solutions was combined and allowed to stand for 30 minutes at about 25° C. This solution was then combined with 100 microliters of ^(99m)TcO₄ ⁻ (approximately 10 mCi/ml or 370.4 MBq/mL) and 100 microliters of a dilute stannous glucoheptonate solution containing 5 micrograms of stannous chloride. This solution was allowed to incubate for 10 minutes at 25° C. The solution was then purified using a Sephadex G-50 column which has been pre-blocked with a 1% solution of human serum albumen in 0.9% NaCl. The column was eluted using 0.9% NaCl. The hottest fraction, as determined by measurements using a Capintec Dose Calibrator was kept and diluted to 50 Mbq/ml using 0.9% NaCl. 0.2 ml, a solution equal to 10 MBq was the injected dose.

Imaging Studies

0.2 ml of ^(99m)Tc radiolabelled B 80 antibody was injected intravenously into the tail vein of the SCID mice prepared as described above. Imaging studies were carried out using a Siemans Orbiter, model 7400 gamma camera with a low energy all purpose collimator using a magnification factor of 2.5. Data was collected using a Picker PCS I-II nuclear medicine computer. Counts were obtained using a 128×128 matrix. Imaging studies were carried out with the mouse conscious in a lucite restraining device with the leg containing the tumor taped to the base plate. The restraining device was placed directly on the collimator. Initial images were carried out between 1 and 7 hours post injection using a five minute data acquisition and repeated at 20 hours using a 15 minute acquisition. Quantification was performed by drawing a region of interest around the tumor. After correction for background counts, comparisons of the norgestrel-stimulated and control tumors were made using counts per pixel values.

Following the final imaging session, the mice were sacrificed by cervical dislocation and samples of blood, leg muscle containing tumor cells, and control muscle from the opposite leg were obtained, weighed and assayed in a gamma well counter (Capintec). From the knowledge of the dose administered and counting efficiency, the percent dose per gram was calculated.

EXAMPLE 3

T-47D tumor cells or MCF-7 tumor cells were implanted into SCID mice and left to develop as tumors over several weeks. Mice were injected subcutaneously with estrogen and/or norgestrel in ethanol (100 μL of a 10⁻³ M solution per mouse) and serum was collected after 48 hours. The results from measuring PSA within the serum by the fluorescence method (57) are found in Table 3.

TABLE 3 Serum PSA Assay, Experiment Tumor Type Estrogen Norgestrel Fluorescence 1 T-47D − + 2818 2 T-47D + + 2661 3 MCF-7 + + 1912 4 MCF-7 − + 6893 5 MCF-7 + − 2067 6 MCF-7 − + 2642

TABLE 2 LIST OF STEROIDS 3β-Acetoxy-9(11),16-allopregnidien-20-one 21-Acetoxyallopregnan-3,20-dione 3β-Acetoxy-5-androsten-17-one 3β-Acetoxybisnor-5-cholenic acid 21-Acetoxy-3α-17-dihydroxy-5β-pregnan-11,20-dione 3α-Acetoxy-5β-etianic acid 3β-Acetoxy-5β-etianic acid 3β-Acetoxy-5-etienic acid 3β-Acetoxyetiocholenic acid 21-Acetoxy-17-hydroxyallopregnan-3,11,20-trione 3β-Acetoxy-5,16-pregnadien-20-one 12α-Acetoxypregnan-3,20-dione 21-Acetoxypregnanedione Acetoxypregnanolone 17-Acetoxypregnenolone 21-Acetoxypregnenolone 3β-Acetoxy-16,(5β)-pregnen-20-one 11α-Acetoxyprogesterone 17-Acetoxyprogesterone 17-Acetoxyprogesterone 3-ethyleneketal 21-Acetoxyprogesterone Δ1-Adrenosterone Adrenosterone Aetiocholane Aldosterone Aldosterone 21-acetate Aldosterone 3-CMO Aldosterone 3-CMO: BSA Aldosterone 18,21-diacetate Aldosterone diacetate 3-CMO Aldosterone diacetate 3-CMO: BSA Aldosterone 21-hemisuccinate Aldosterone 21-hemisuccinate: BSA Allocholesterol Allodihydrocorticosterone Allodihydrocortisol Allodihydrocortisone Allodihydrocortisone acetate Allodihydro substance “S” Allodihydrotestosterone Allopregnanediol Allopregnanolone Allopregnanolone acetate Allotetrahydro compound “A” Allotetrahydro compound “B” Allotetrahydro compound “E” Allotetrahydro compound “F” Allotetrahydrocorticosterone Allotetrahydrocortisol Allotetrahydrocortisone Allotetrahydro-11-dehydrocorticosterone Allotetrahydrodesoxycorticosterone Allotetrahydrodesoxycorticosterone 21-acetate Allotetrahydro-11-desoxycortisol Allotetrahydro DOC Allotetrahydro DOC 21-acetate Allotetrahydrohydrocortisone Allotetrahydro substance “Q”. Allotetrahydro substance “S” Allo TH “A” Allo TH “B” Allo TH “E” Allo TH “E” diacetate Allo TH “F” Allo TH “F” diacetate Allo TH “S” Androstadienedione Androstadienedione 3-erhylenoI erher Androstanedione Androstanolone Androstatriendione Androstenediol Androstenedione Androstenolone 4-Androsten-17β-ol-one enol diacetate Androsterone Androsterone acetate Androsterone benzoate Androsterone chloroformate Androsterone-CMO Androsterone glucuronide Androsterone hemisuccinate Androsterone propionate Androsterone sodium sulfate Androsterone tosylate Anhydroxyprogesterone Apocholic acid Beclomethasone Beclomethasone 21-acetate Beclomethasone 17,21-dipropionate Beclomethasone 21-hemisuccinate Beclomethasone 21-propionate Betamethasone Betamethasone 21-acetate Betamethasone 17,21-dipropionate Betamethasone 21-disodium phosphate Betamethasone 21-hemisuccinate Betamethasone 17-valerate 3,4-Bis(4-hydroxyphenl)-hexane 3,4-Bis-(4-hydroxyphenyl)-3-hexene Bolderone Bolderone sulfate, sodium salt 2α-Bromo-5α-cholestan-3-one 4-Bromoequilenin 4-Bromoequilin 2-Bromoestradiol 4-Bromoestradiol 16α-Bromoestradiol 16α-Bromo-17α-estradiol 16α-Bromoestrone 16β-Bromoestrone 2-Bromoethynylestradiol 4-Bromoethynylestradiol 17-Bromopregnenolone 17-Caproxyprogesterone Chenodeoxycholic acid Chenodeoxycholic acid 3-Hemisuccinate Chenodeoxycholic acid methyl ester Chenodeoxycholic acid sodium salt 3β-Chloro-5α-cholestane 3β-Chloro-5-cholestene 21-Chloro-17-hydroxyprogesterone Cholaic acid α-Cholestanol β-Cholestanol Cholestanol Cholestanol acetate Cholestanol benzoate Cholestanol hemisuccinate Cbolestanol propionate Cholestanol rosylate 5-Cholestan-3β-ol chloride Cholestanone 5α-Cholestan-3-one enol acetate 5α-Cholestan-3β-yl chloride Cholestanyl chloride Cholestene Cholestenol 5-Cholesten-3β-yl chloride Cholestenone 4-Cholesten-3-one enol acetate Cholesterilene Cholesterin Cholesterol Cholesteryl acetate Cholesteryl acetoacetate Cholesteryl benzoate Cholesteryl n-butyrate Cholesteryl caprylate Cholesteryl chloride Cholesteryl chloroacetate Cholesteryl chloroformate Cholesteryl cinnamate Cholesteryl n-decylate Cholesteryl ethylether Cholesteryl formate Cholesteryl glucuronide, sodium salt Cholesteryl hemisuccinate Cholesteryl heptanoate Cholesteryl hexadecanoate Cholesteryl hydrocinnamate Cholesteryl hydrogen phthalate Cholesteryl iso-butytate Cholesteryl laurate Cholesteryl methylcarbonate Cholesteryl methyl echer Cholesteryl myristate Cholesteryl nonanoate Cholesteryl octanoate Cholesteryl pelargonate Cholesteryl β-phenylpropionate Cholesteryl n-propionate Cholesteryl pyridinium sulfate Cholesteryl sodium sulfate Cholesteryl stearate Cholesteryl rosylate Cholesteryl valerate Cholic acid Cholic acid methyl ester Cholic acid sodium salt Cinchol Cistestosterone Coprostane Coprostanol Coprostanol acetate Coprostanol benzoate Coprostan-3-one Coprostenol Coprosterol Cortexolone Cortexone Corticosterone Corticosterone acetate Corticosterone 21-acetate, 3-CMO Corticosterone 21-acetate, 3-CMO: BSA Corticosterone 3-CMO Corticosterone 3-CMO: BSA Corticosterone diethyleneketal Corticosterone hemisuccinate Corticosterone hemiuccinate: BSA Cortisol Cortisol acetate Cortisol 21-acetate, 3-CMO Cortisol 21-acetate, 3-CMO: BSA Cortisol 3-CMO Cortisol 3-CMO: BSA Cortisol glucuronide Cortisol glucuronide, sodium salt Cortisol hemisuccinate Cortisol 17-valerate Δ1-Cortisone Cortisone Cortisone acetate Cortisone 21-acetate, 3-CMO Cortisone 21-acetate, 3-ethyleneketal Cortisone diethyleneketal Cortisone 21-hemisuccinate Cortisone 21-sodium sulfate Cortol β-Cortol Cortolone β-Cortolone DES DHEA DHEA acetate DOCA DOCA 3-ethyleneketal DOC 21-aldehyde hemiacetal DOC 3-CMO DOC 3-CMO: BSA DOC glucuronide DOC hemisuccinate DOC propionate DPA 16-Dehydroallopregnanolone 16-Dehydroallopregnanolone acetate 24-Dehydrocholesterol Dehydrocholic acid 1-Dehydrocortisone 11-Dehydrocorticosterone 11-Dehydrocorticosterone acetate 11-Dehydrocorticosterone hemisuccinate Dehydrocortisol Dehydroepiandrosterone Dehydroepiandrosterone acetate Dehydroepiandrosterone glucuronide Dehydroepiandrosterone potassium sulfate Dehydroepiandrosterone propionate Dehydroepiandrosterone sodium sulfate Dehydroepiandrosterone tosylate 6-Dehydro-17α-etradiol 6-Dehydroestradiol 6-Dehydroestradiol diacetate 7-Dehydro-17α-estradiol 7-Dehydro-17β-estradiol 7-Dehydro-17β-estradiol diacetate 16-Dehydroestradiol diacetate 6-Dehydroestrone 6-Dehydroestrone acetate 6-Dehydroestrone benzoate 6-Dehydroestrone benzyl ether 6-Dehydroestrone methyl ether 8-Dehydroestrone Dehydroisoandrosterone Dehydroisoandrosterone acetate 1-Dehydromethyltestosterone 16-Dehydro-5α-pregnan-3β-ol 11,20-dione 16-Dehydro-5α-pregnan-3β-ol 11,20-dione acetate 16-Dehydropregnanolone 16-Dehydropregnanolone acetate 16-Dehydro-5α-pregnan-3β-ol 20-one 16-Dehydro-5α-pregnan-3β-ol 20-one acetate 16-Dehydro-5β-pregnan-3β-ol 20-one 16-Dehydro-5β-pregnan-3β-ol 20-one acetate 16-Dehydropregnenolone 16-Dehydropregnenolone acetate 16-Dehydropregnenolone acetate, oxime 16-Dehydropregnenolone oxime 16-Dehydroprogesterone 16-Dehydrorestosterone 1-Dehydrotestosterone acetate 1-Dehydrotestosterone benzoate 1-Dehydrotestosterone 3-CMO 1-Dehydrotestosterone hemisuccinate 1-Dehydrotestosterone propionate 1-Dehydrotestosterone sodium sulfate 6-Dehydrotestosterone 6-Dehydrotestosterone acetate 6-Dehydrotestosterone benzoate 6-Dehydrotestosterone 3-CMO 6-Dehydrotestosterone hemisuccinate 6-Dehydrotestosterone propionate Deoxycholic acid Deoxycholic acid diacetate Deoxycholic acid sodium salt Desmosterol Desmosterol acetate Desonide Desoxycorticosterone Desoxycorticosterone acetate Desoxycorticosterone acetate 3-CMO Desoxycorticosterone acetate 3-CMO: BSA Desoxycorticosterone acetate, 3-ethyleneketal Desoxycorticosterone 21-aldehyde hemiacetal Desoxycorticosterone 3-CMO Desoxycorticosterone 3-CMO: BSA Desoxycorticosterone glucuronide Desoxycorticosterone hemisuccinate Desoxycorticosterone propionate 11-Desoxycortisol 21-Desoxycortisol 21-Desoxycortisone 17-Desoxycortol 17-Desoxy-β-cortol 17-Desoxyβ-cortolone 11-Desoxy-17-hydroxycorticosterone Desoxymethasone Dexamethasone Dexamethasone acetate Dexamethasone hemisuccinate Dexamethasone hemisuccinate: BSA Dexamethasone 21-mesylate Dexamethasone phosphate disodium salt Dianabol 2,4-Dibromoestradiol Dichlorisone 3α, 12α-Diformyloxydesoxycholic acid Dihydroandrosterone Dihydrocholesterol Dihydrocholesterol acetate Dihydrocholesterol benzoate Dihydrocholesterol hemisuccinate Dihydrocholesterol methyl ether Dihydrocholesterol propionate Dihydrocholesterol tosylate 5α-Dihydrocortexone 5α-Dihydrocorticosterone 5α-Dihydrocortisol 5α-Dihydrocortisone acerate 20β-Dihydrocorticosterone 20β-Dihydrocortisol Dihydrocortisone 5α-Dihydrocortisone 5β-Dihydrocortisone Dihydrocortisone acetate 5α-Dihydro-11-dehydrocorticosterone Dihydro-11-desoxycortisol 17β-Dihydroequilenin 17β-Dihydroequilenin diacetate 17α-Dihydroequilin 17β-Dihydroequilin 17β-Dihydroequilin diacetate 20β-Dihydro Kendall's compound “B” 5α-Dihydro substance “Q” 5α-Dihydro substance “S” 5α-Dihydrotestosterone Dihydrotestosterone Dihydrotestosterone acetate Dihydrotestosterone benzoate Dihydrotestosterone 3-CMO Dihydrotestosterone 3-CMO: BSA Dihydrotestosterone chloroformate Dihydrotestosterone cyclopentylpropionate Dihydrotestosterone enanthate Dihydrotestosterone glucuronide Dihydrotestosterone hemisuccinate Dihydrorestosterone hemisuccinate: BSA Dihydrotesrosterone hexahydrobenzoate Dihydrotestosterone propionate Dihydrotestosterone tosylate 5β-Dihydrorestosterone 5β-Dihydrotesrosterone acetate 5β-Dihydrotesrosterone 3-CMO 5β-Dihydrotestosterone hemisuccinate 5β-Dihydrotesrosterone propionate 3α,12α-Dihydroxycholanic acid 5β-Dihydroxycorticosterone 3α,7α-Dihydroxy-12-ketocholanic acid 3α,12α-Dihydroxynorcholanate 3β,17-Dihydroxy-5-pregnen-3-one Dihydro Reichstein's substance “S” 3,6-Diketocholanic acid 3,7-Diketocholanic acid 3,12-Diketocholanic acid 7,12-Diketolithocholic acid 7,12-Diketolithocholic acid sodium salt 6,16-Dimethyl-16-dehydroprogesterone 2,4-Dinitroestradiol Diosgenin Diosgenin acecate Diosgenin benzoate E 1 E 2 E 3 E 4 α-Ecdysone Electrocortin Epi-allocholesterol Epi-allotetrahydro “B” Epiandrosterone Epiandrosterone acetate Epiandrosterone benzoate Epiandrosterone chloroformate Epiandrosterone 17-CMO Epiandrosterone glucuronide Epiandrosterone hemisuccinate Epiandrosterone potassium sulfate Epiandrosterone propionate Epiandrosterone sodium sulfate Epiandrosterone tosylate Epicholestanol Epicholesterol Epi compound “F” Epicoprostanol Epicoprostanol acetate Epicoprostanol benzoate Epicoprostanol hemisuccinate Epicoprostanol propionate Epicoprosterol Epidihydrocholesterol 16-Epiestriol 16-Epiestriol 3-methylether 16-Epiestriol triacetate 17-Epiestriol 17-Epiestriol triacetate 16,17-Epiestriol 16,17-Epiestriol triacetate Epitestosterone Epitestosterone acetate Epitestosterone benzoate Epitestosterone hemisuccinate 11-Epi Tetrahydro compound “B” 11-Epi-Tetrahydro compound “F” 11-Epi-Tetrahydrocorticosterone 11-Epi-Tetrahydrocortisol 11-Epi-Tetrahydrohydrocortisone 11-Epi-TH “B” 11-Epi-TH “F” Epoxypregnanolone Epoxypregnenolone Epoxypregnenolone acetate 16α,17-epoxyprogesterone d-Equilenin d-Equilenin acetate d-Equilenin benzoate d-Equilenin benzyl ether d-Equilenin etheyl ether d-Equilenin methyl ether Equilin Equilin acetate Equilin benzoate Equilin methylether 4,22-Ergostadien-3-one Ergosterol Esmilagenin Estetrol 17α-Estradiol 17α-Estradiol 3-acetate 17α-Estradiol 17-acetate 17α-Estradiol diacecate 17β-Estradiol 17β-Estradiol 3-acetate 17β-Estradiol 17-acetate 17β-Estradiol 17-acetate, 3-benzoate 17β-Estradiol 17-acetate, 3-methyl ether 17β-Estradiol 3-benzoate 17β-Estradiol 3-benzoate, 17-valerate 17β-Estradiol 3-benzyl ether 17β-Estradiol 17-cyclopentylpropionate 17β-Estradiol diacetate 17β-Estradiol dibenzoate 17β-Estradiol dicyclopentylpropionate 17β-Estradiol diglucuronide 17β-Estradiol dihemisuccinate 17β-Estradiol dipalmitate 17β-Estradiol diphosphate, disodium salt 17β-Estradiol dipropionate 17β-Estradiol disodium sulfate 17β-Estradiol 17-enanthate 17β-Estradiol 3-glucuronide 17β-Estradiol 17-glucuronide 17β-Estradiol 3-hemisuccinate 17β-Estradiol 17-hemisuccinate 17β-Estradiol 17-hemisuccinate: BSA 17β-Estradiol 17-hexahydrobenzoate 17β-Estradiol 3-methyl ether 17β-Estradiol 17-phenylpropionate 17β-Estradiol 3-phosphate, disodium salt 17β-Estradiol 17-phosphate, disodium salt 17β-Estradiol 3-sodium sulfate 17β-Estradiol 17-sodium sulfate 17β-Estradiol 17-stearate 17β-Estradiol 17-valerate Estriol Estriol 3-acetate Estriol 16-acetate Estriol 16,17-diacetate Estriol 3,17-disodium sulfate Estriol 16,17-disodium sulfate Estriol 3-glucuronide, sodium salt Estriol 3-hemisuccinate Estriol 16-hemisuccinate Estriol 3-methyl ether EsEriol 3-phosphate, disodium salE Estriol 3-sodium sulfate Estriol 17-sodium sulfate Estriol triacetate Estriol tripropionate Estrone Estrone acetate Estrone benzoate Estrone benzyl ether Estrone 17-enol acetate, 3-methyl ether Estrone enol diacetate Estrone ethyl ether Estrone glucuronide, sodium salt Estrone hemisuccinate Estrone methoxime Estrone methyl ether Estrone phosphate, disodium salt Estrone propionate Estrone trimethylacetate Ethisterone 24b-Ethylcholesterol 17α-Ethyl-19-nor-testosterone Ethynodiol Ethynylandrostanolone Ethynylandrostendiol Ethynylandrostenolone 17α-Ethynyldihydrotestosterone Ethynylestradiol 17α-Ethynylestradiol 3-acetate Ethynylestradiol 3-methyl ether 17α-Ethynyl-19-nor-testosterone Ethynyltestosterone Etiadienic acid Etiadienic acid 3-acetate Etiadienic acid methyl ester Etianic acid Etienic acid Etienic acid acetate Etienic acid methyl ester Etiocholane Etiocholan-3α,17α-diol Etiocholan-3α,17β-diol Etiocholan-3α,17β-diol diacetate Etiocholan-3β,17α-diol Etiocholan-3β,17β-diol Etiocholan-3β,17β-diol diacetate Etiocholan-3α,6α-diol-17-one Etiocholan-3α,11β-diol-17-one Etiocholan-3,17-dione Etiocholan-3α-ol Etiocholan-3α-ol-11,17-dione Etiocholanolone Etiocholanolone acetate Etiocholanolone benzoate Etiocholanolone 17-CMO Etiocholanolone glucuronide Etiocholanolone hemisuccinate Etiocholanolone potassium sulfate Etiocholanolone propionate Etiocholanolone sodium sulfate Etiocholan-3β-ol-17-one Etiocholan-17β-ol-13-one Etiocholan-3β-ol-17-one acetate Etiocholan-3β-ol-17-one benzoate Etiocholan-3β-ol-17-one hemisuccinate Etiocholan-3β-ol-17-one propionate Etiocholenic acid acetate Flucinonide Flumethasone Fluocinolone acetonide 2-Fluoroestradiol Fluorometholone Fluoxymesterone Flurandrenolide Flurocortisone Fucosterol Glycochenodeoxycholic acid Glycochenodeoxycholic acid sodium salt Glycocholanic acid Glycocholic acid Glycocholic acid potassium salt Glycocholic acid sodium salt Glycodehydrocholic acid Glycodehydrocholic acid sodium salt Glycodeoxycholic acid Glycodeoxycholic acid sodium salt Glycohyodeoxycholic acid Glycohyodeoxycholic acid sodium salt Glycolithocholic acid Glycolithocholic acid sodium salt Hecogenin Hecogenin acetate Hetero-1-methylestradiol diacetate 6β-Hydrocortisol Hydrocortisone 11α-Hydrocortisone Hydrocortisone acetate Hydrocortisone acetate, 3-CMO Hydrocortisone acetate, 3-CMO: BSA Hydrocortisone 3-CMO Hydrocortisone 3-CMO: BSA Hydrocortisone glucuronide Hydrocortisone hemisuccinate Hydrocortisone hemisuccinate: BSA 3β-Hydroxy-5α-androstan-17-one 4-Hydroxyandrostenedione 7α-Hydroxyandrostenedione 19-Hydroxy-4-androsten-3,17-dione 17β-Hydroxy-4-androsten-3-one 16α-Hydroxyandrosterone 3β-Hydroxy nor-5-cholenic acid 3β-Hydroxy- cholenic acid 4β-Hydroxycholesterol 7α-Hydroxycholesterol 7β-Hydroxycholesterol 19-Hydroxycholesterol 20α-Hydroxycholesterol 25-Hydroxycholesterol Hydroxycholic acid 6β-Hydroxycorticosterone 17-Hydroxycorcticosterone 6β-Hydroxycortisol 18-Hydroxy-11-deoxycorticosterone 3α-Hydroxy-7,12-diketocholanic acid 18-Hydroxy DOC 2-Hydroxyestradiol 2-Hydroxyestradiol 17-acetate 2-Hydroxyestradiol 3-methyl ether 4-Hydroxyestradiol 6α-Hydroxyestradiol 11α-Hydroxyestradiol 16α-Hydroxy-17β-estradiol 16β-Hydroxy-17β-estradiol 2-Hydroxyestriol 15α-Hydroxyestriol 2-Hydroxyestrone 4-Hydroxyestrone 16α-Hydroxyestrone 2-Hydroxyestrone-3-methyl ether 3β-Hydroxy-5α-etianic acid 3β-Hydroxy-5α-etianic acid methyl ester 3α-Hydroxy-5β-etianic acid 3α-Hydroxy-5β-etianic acid methyl ester 3β-Hydroxy-5β-etianic acid 3β-Hydroxy-5β-etianic acid methyl ester 11β-Hydroxyetiocholanolone 16α-Hydroxyetiocholanolone 3β-Hydroxy-5-etiocholenic acid 3α-Hydroxy-6-ketocholanic acid 11α-Hydroxymethyltestosterone 6β-Hydroxyprednisolone 17-Hydroxypregnanolane 16α-Hydroxypregnenolone 17-Hydroxypregnenolone 17-Hydroxypregnenolone 3-acetate 21-Hydroxypregnenolone 2α-Hydroxyprogesterone 6α-Hydroxyprogesterone 6β-Hydroxyprogesterone 6β-Hydroxyprogesterone acetate 6β-Hydroxyprogesterone hemisuccinate 6β-Hydroxyprogesterone hemisuccinate: BSA 11α-Hydroxyprogesterone 11α-Hydroxyprogesterone acecate 11α-Hydroxyprogesterone hemisuccinate 11α-Hydroxyprogesterone hemisuccinate: BSA 11α-Hydroxyprogestrone tosylate 11β-Hydroxyprogestrone 12α-Hydroxyprogestrone 17-Hydroxyprogestrone 17-Hydroxyprogestrone 3-CMO 17-Hydroxyprogestrone 3-CMO: BSA 18-Hydroxyprogestrone 19-Hydroxyprogestrone 20α-Hydroxyprogestrone 20β-Hydroxyprogestrone 21-Hydroxyprogestrone 6β-Hydroxytestosterone 7α-Hydroxytestosterone 11α-Hydroxytestosterone 11α-Hydroxytestosterone hemisuccinate 11α-Hydroxytestosterone hemisuccinate: BSA 11β-Hydroxytestosterone 16α-Hydroxytestosterone 16β-Hydroxytestosterone 19-Hydroxytestosterone 11α-Hydroxytigogenin Hyocholic acid Hyocholic acid methyl ester Hyodeoxycholic acid Hyodeoxycholic acid methyl ester Iodocholestrol Isoallospirostan-3β,12β-diol Isoandrosterone 14-iso-Equilenin acetate 14-iso-Equilenin methyl ether Isoergosterone Iso-Sarsasapogenin Kendall's compound “A” Kendall's compound “B” Kendall's compound “C” Kendall's compound “E” Kendall's compound “E” acetate Kendall's compound “F” Kendall's compound “G” Kendall's compound “H” Kendall's desoxy compound “B” 11-Ketoandrosterone Ketocholanic acid 3-Ketocholanic acid 6-Ketocholestanol 6-Ketocholestanol acetate 7-Ketocholestanol 6-Ketocholestenone 7-Ketocholesterol 7-Ketocholesterol acetate 18-Ketocorticosterone 7-Ketodeoxycholic acid 6-Keto-17α-estradiol 6-Keto-17α-estradiol 6-CMO 6-Keto-17α-estradiol 6-CMO: BSA 6-Keto-17β-estradiol 6-Keto-17β-estradiol 6-CMO 6-Keto-17β-estradiol 6-CMO: BSA 16-Keto-17β-estradiol 6-Ketoestriol 6-CMO 6-Ketoestriol 6-CMO: BSA 6-Ketoestriol triacetate 6-Ketoestrone 6-Ketoestrone acetate 6-Ketoestrone 6-CMO 6-Ketoestrone 6-CMO: BSA 16-Ketoestrone 6-Ketoethynylestradiol 6-Ketoethynylestradiol 6-CMO 6-Ketoethynylestradiol 6-CMO: BSA 3-Keto-5α-etianic acid 3-Keto-5β-etianic acid 3-Ketoetiocholanic acid 3-Ketoetiocholanic acid methyl ester 11-Ketoetiocholanolone 3-Keto-4-etiocholenic acid 3-Keto-4-etiocholenic acid ethyl ester 3-Keto-4-etiocholenic acid methyl ester 11-Ketoisoandrosterone 6-Ketolithocholic acid 7-Ketolithocholic acid 12-Ketolithocholic acid 12-Ketolithocholic acid acetate, methyl ester 12-Ketolithocholic acid benzoate, methyl ester 11-Ketopregnanolone 11-Ketopregnanolone acetate 7-Ketopregnenolone 6-Ketoprogesterone 11-Ketoprogesterone 11-Ketotestosterone 16-Ketotestosterone 16-Ketotestosterone acetate 11-Ketotigogenin Lanosterol Lithocholic acid Lithocholic acid acetate Lithocholic acid acetate methyl ester Medroxyprogesterone Megestrol acetate Meprednisone Mestranol 4-Methoxyestradiol 2-Methoxyestrapentol 4-Methoxyestriol 2-Methoxyestrone 4-Methoxyestrone 2-Methoxyestrone 3-methyl ether 2-Methoxyethynylestradiol 16α-Methyl-17-acetoprogesterone Methyl-3α-Acetoxycholanate Methyl-7α-acetoxy-3,12-diketocholanate Methyl-3α-acetoxy-12α-hydroxycholanate Methyl-3α-acetoxy-12-ketocholanate Methylacetoxylithocholate Methylandrostanediol Methylandrostanolone Methylandrostendiol Methylchenodeoxycholic diacetate Methylchenodeoxycholate Methyl cholate Methyl cholate 3,7-diacetate 6α-Methylhydrocortisone Methyldehydrocholate 9(11)-Methyl dehydrotestosterone Methyldeoxycholate 6α-Methyl-11-desoxycortisol 17α-Methyldihydrotestosterone 3-CMO Methyldihydrotestosterone Methyl-3α,12α-dihydroxynorcholanate Methyl-3α,12α-diol diacetoxynorcholanate 6-Methylidiosgenin 6-Methylidiosgenin acetate 6-Methylepoxypregnenolone 7α-Methylestradiol Methylestradiol 3-methyl ether 1-Methylestrone 7α-Methylestrone 6α-Methyl-17-hydroprogesterone 16α-Methyl-17-hydroprogesterone Methylhydroxytigogenin Methylhydroxytigogenin 3-acetate Methylhyoxycholate Methyl lithocholate 7α-Methyl-19-nor-testosterone 17α-Methyl-19-nor-testosterone Methyloxyprogesterone 6α-Methylprednisolone 6α-Methylprednisolone acetate 6α-Methylprednisolone hemisuccinate 6α-Methylprednisolone sodium succinate 16β-Methylprednisone 6-Methylpregnenolone 6-Methylpregnenolone acetate 16α-Methylpregnenolone 16β-Methylpregnenolone 16α-Methylpregnenolone 16α-Methyl substance “S” 16α-Methyl substance “S” acetate Methyltestosterone Δ1-Methyltestosterone 17α-Methyl-Δ1-testerone 2-Methyoxyestradiol 2-Methyoxyestradiol 3-methyl ether Methyl-3β,12α-diacetoxycholanate Methyl-3β,12α-diacetoxydeoxycholanate Murocholic acid α-Muricholic acid β-Muricholic acid Nandrolone Neocholestene Nilevar 6-Nitrocholesteryl acetate 6-Nitrocholesteryl benzoate 2-Nitroestradiol 2-Nitroestrone 19-Nor-4-androsten-3,17-dione 19-Nor-4-androsten-17α-ethyl-17β-ol-3-one 19-Nor-4-androsten-17α-ethynyl-17β-ol-3-one 19-Nor-4-androsten-17β-ol-3-one 19-Nor-Androsterone Nordeoxycholic acid Nordeoxycholic acid diacetate Nordeoxycholic acid diacetate, methyl ester Nordeoxycholic acid methyl ester Norethandrolone Norethindrone 19-Nor-4-ethisterone Norethynodrel Norgestrel Norlutin 19-Norprogesterone 19-Nortestosterone 19-Nortestosterone acetate 19-Nortestosterone benzoate 19-Nortestosterone 3-CMO 19-Nortestosterone dichloroacetate 19-Nortestosterone hemisuccinate 19-Nortestosterone propionate 19-Nortestosterone sodium sulfate Oxandrolone Oxymetholone Prednisolone Prednisolone acetate Prednisolone 21-carboxylic acid Prednisolone hemisuccinate Prednisolone 21-phosphate, disodium salt Prednisone Prednisone acetate Prednisone 21-hemisuccinate Na salt Pregnanediol Pregnanediol diacetate Pregnanedione Pregnanetriol Pregnanetriol 3-glucoronide sodium salt Pregnanetriolone Pregnanolone Pregnanolone acetate Pregnanolone hemisuccinate 4-Pregnen-11β,21-diol-3,20-dione 18-al Pregnenindiol Pregnenolone Pregnenolone acetate Pregnenolone acetate oxime Pregnenolone 20-CMO Pregnenolone glucuronide Pregnenolone hemisuccinate Pregnenolone methyl ether Pregnenolone sodium sulfate Pregnenolone tosylate Δ1-Progesterone Progesterone Progesterone 3-CMO Progesterone 3-CMO: BSA Provera Reichstein's epi “U” Reichstein's substance “A” Reichstein's substance “B” Reichstein's substance “Dehydro C” Reichstein's substance“D” Reichsrein8s substance Epi “E” Reichstein's substance “E” Reichstein's substance “Fa” Reichstein's substance “G” Reichstein's substance “H” Reichstein's substance “J” Reichstein's substance “K” Reichstein's substance “L” Reichstein's substance “M” Reichstein's substance “N” Reichstein's substance “O” Reichstein's substance “P” Reichstein's substance “Q” Reichstein's substance “R” Reichstein's substance “S” Reichstein's substance “T” Reichstein's substance “U” Reichstein's substance “V” Rockogenin Sarsasapogenin Sarsasapogenin acetate β-Sitosterol β-Sitosterol acetate Smilagenin Smilagenin acetate Sodium cholate Sodium dehydrocholate Sodium glycochenodeoxycholate Sodium glycocholate Sodium glycodehydrocholate Sodium glycodeoxycholate Sodium glycohyodeoxycholate Sodium glycolithocholate Sodium lithocholate Sodium taurochenodeoxycholate Sodium taurocholanic acid Sodium taurocholate Sodium taurodehydrocholate Sodium taurodeoxycholate Sodium taurohyodeoxcholate Sodium taurolithocholate Stanolone Stigmasradienone Stigmasterol Stigmasterol acetate Stilbestrol Taurochenodeoxycholic acid Taurochenodeoxycholic acid sodium salt Taurocholanic acid Taurocholanic acid sodium salt Taurocholic acid Taurocholic acid sodium salt Taurodehydrocholic acid Taurodehydrocholic acid sodium salt Taurodeoxycholic acid Taurodeoxycholic acid sodium salt Taurohyodeoxycholic acid Taurohyodeoxycholic acid sodium salt Taurolithocholic acid Taurolithocholic acid sodium salt Testane Δ1-Testosterone Δ1-Testosterone acetate Δ1-Testosterone benzoate Δ1-Testosterone 3-CMO Δ1-Testosterone hemisuccinate Δ1-Testosterone hexahydrobenzoate Δ1-Testosterone propionate Δ1-Testosterone sodium sulfate Testosterone Testosterone acetate Testosterone benzoate Testosterone 3-CMO Testosterone 3-CMO: BSA Testosterone cyclopentylpropionate Testosterone dichloroacetate Testosterone enol diacetate Testosterone 3-ethyleneketal Testosterone glucuronide Testosterone glucuronide sodium salt Testosterone hemisuccinate Testosterone hemisuccinate: BSA Testosterone hexahydrobenzoate Testosterone phosphoric acid Testosterone potassium sulfate Testosterone propionate Testosterone sodium sulfate Testosterone tosylate Tertahydro compound “A” Tertahydro compound “B” Tertahydro compound “E” Tertahydro compound “E” acetate Tetrahydro compound “F” Tertahydrocortexolone Tetrahydrocorticosterone Tetrahydrocortisol Tetrahydrocortisone Tertahydrocortisone acetate Tetrahydro-11-dehydrocorticosterone Tetrahydrodesoxycorticosterone Tetrahydro-11-desoxycortisol Tertahydro DOC Tetrahydro hydrocortisone Tertahydro substance “Q” Tetrahydro substance “S” Tertahydro substance “S” 21-acetate TH “A” TH “B” TH “E” TH “F” TH “S” TH “S”21-acetate Theelol Tigogenin Tigogenin acetate Transdehydroandrosterone Transestriol Triamcinolone Triamcinolone acetonide Triamcinolone diacetate Triendiol Triketocholanic acid Urocortisol Urocortisone Ursocholanic acid Ursodeoxycholic acid Wintersteiner's compound “A” Wintersteiner's compound “B” Wintersteiner's compound “D” Wintersteiner's compound “F” Wintersteiner's compound “G”

References

1. Cuschieri, A., 1986. Tumors of the breast: an overview, In: Comprehensive Textbook of Oncology, Wiliams & Wilkins p.1002 -1009.

2. Anonymous, 1993. Breast Cancer In: Handbook of U.S. Desease Incidence and Prevalance Bio. Bus. Int. p.1-15

3. Harris, J. R., Lippman, M. E., Veronesi, U., Willett, W. 1992. Breast cancer. New Engl. J. Med., V 327, p. 319-328

4. Harris, J. R., Lippman, M. E., Veronesi, U., Willett, W. 1992. Breast cancer. New Engl. J. Med., V 327, p.390-398.

5. Harris, J. R., Lippman, M. E., Veronesi, U., Willett, W. 1992. Breast cancer. New Engl. J.

Med., V 327, p.473-480.

6. Kaplan, W. D. 1988. Introduction: Current status of tumour imaging In: Antibodies in Radiodiagnosis and Therapy, CRC Press p.2-12.

7. Lentle, B. C., Scott, J. R., Schmidt, R. P., Hopper, H. R., and Catz, Z., 1985, Clinical value of direct tumor scintigraphy: a new hypothesis, J. Nucl. Med., V. 26, p. 1215.

8. Wagner, H. N. 1992. Annual meeting highlights: molecules with messages, J. Nucl. Med., 33:8:p.12 N.

9. Davis, M. A. and Jones, A. G. 1976. Comparison of 99mTc-phosphonate and phosphonate agents for skeletal imaging, Semin. Nucl. Med.,6: p19

10. Brady, L. W. and Croll, M. N., 1979. The role of bone scanning in the cancer patient, Skel. Radiol., V 3, p217.

11. Waxman, A. D. 1982. Scintigraphic evaluation of diffuse hepatic disease, Semin. Nucl. Med.,V 12, p 75.

12. Drum, D. E. 1982. Current status of radiocolloid hepatic scintiphotography for space-occupying disease. Semin. Nucl. Med.,V 13, p 64.

13. Ege, G. N., 1976 Internal mammary lymphoscintigraphy. The rationale, technique, interpretation and clinical application: a review based on 848 cases, Radiology, V 118, p.101

14. Grove, R. B., Reba, R. C., Eckelman, W. C., and Goodyear, M., 1974. Clinical evaluation of radiolabelled bleomycin for tumor detection, J. Nucl. Med., V15, p. 386

15. Hoffer, P., 1980. Status of gallium 67 in tumor detection, J. Nucl. Med., V 21 p. 394.

16. Johnston, G. S., 1981. Clinical applications of gallium in oncology, Int.J. Nucl. Med. Biol. V 8, p.249.

17. Silberstein, E, B., 1978. Gallium scanning in inflammatory and neoplastic conditions, Clin. Nucl. Med., V 6, p.63.

18. Hoffer, P., 1978. The utility of gallium-67 tumor imaging: a comment on the final reports of the cooperative study group. J. Nucl. Med., V 19, p. 1082.

19. Strauss, L. G. and Conti, P. S. 1991. The applications of PET in clinical oncology. J. Nucl. Med. V 32,N 4, p. 623-648.

20. Wahl, R. L. 1990. Sequential quantitative FDG/PET assessment of the metastatic response of breast carcinomas to chemotherapy. J. Nucl. Med. V 31, p.746.

21. Sigurdson, E. R. and Cohen, A. M. 1991. Commentary on applications of PET in clinical oncology. J. Nucl. Med. V 32. p. 649.

22. Spicer, J., Duncan, W. P. and Rotert, G. A. 1984. U.S. Pat. No. 4,659,517

23. Hochberg, J. 1984. U.S. Pat. No. 4,465,676

24. Pomper, M. G., VanBrocklin, H.,and Thieme, A. M. 1990. 11β-methoxy and 16α-fluoroestradiols: receptor based imaging agents. J. Med. Chem. 33:3143-3155

25. Katzenellenbogan, J. A., McElvany K. D. et al. 1982. 16α-⁷⁷Br-bromo-11β-methoxyestradiol: a gamma emitting estrogen imaging agent with high uptake and retention in target organs. J Nucl. Med. 23:411-419.

26. Hanson, R. N., Franke, L. A. et al. 1984. Preparation and evaluation of 17α-[¹²⁵I]-iodovinyl-11β-methoxyestradiol as a selective radioligand for tissues containing estrogen receptors: concise communication, J. Nucl. Med. 25:998-1002.

27. Lipman, M. E., Do, H. M. T., and Hochberg, R. B. 1991. Specific estrogen receptor binding and biological effects of 16 α-iodoestradiol on human breast cancer cells. Cancer Res. V 41, p.3150-3154.

28. Zielinski, J. E., Larner, J. M., Hoffer, P. B., and Hochberg, R. B. 1989. The synthesis of 11β-methoxy-(16α-¹²³I) iodoestradiol and its interaction with estrogen receptor in vivo and in vitro. J. Nucl. Med. V 30, p.209-215.

29. Ryan, J. W., Rotmensch, J., Pan M-L, et al. 1989. Human biodistribution studies of a novel non-steroidal estrogen (I-123-IBHPE) J. Nucl. Med. V 30, p.883.

30. DeSombre, E. R., Hughes A., Shafii, B. et al. 1992. Estrogen receptor directed radiotoxicity with Auger-electron-emitting nuclides: 17 α(¹²³I)-11β-methoxtestradiol and CHO-ER cells. In: Biophysical aspects of Auger Process. AIP Press p.352-371.

31. McLaughin, W. H., Milius, R. A., Pillai, K. M., and Blumenthal R. D. 1989. Cytotoxicity of receptor mediated 16α-(¹²⁵I) iodoestradiol in cultured MCF-7 human breast cancer cells. J. Natl. Cancer Inst. V 81, p.437-440.

32. DiZio, J. P., Anderson, C. J. et al.1992. Technetium- and rhenium-labelled progestins: synthesis, receptor binding and in vivo distribution of an 11β-substituted progestrin labelled with technetium-99m and rhenium-186. J. Nucl. Med. 33:558-569.

33. Hansen, J. 1975. U.S. Pat. No. 3,927,193

34. Goldenberg, M. D., DeLand, F., Kim, F. 1978. Use of radiolabelled antibodies to carcinoembryonic antigen for the detection and localization of diverse cancers by external photoscanning. N Engl J Med, 298:1384-1388.

35. Kohler, G. and Milstein, C. 1975. Continuous culture of fused cells secreting antibodies of predefined specificity. Nature, 256:495-497.

36. Neal, C. E., Baker, M. R., and Texter, J. H. 1992. Prostate imaging with antibodies. Appl. Radiology, 21:39-46.

37. Wynant, G. E., Murphy, G. P., and Horoszewicz, J. S. 1991. Immunoscintigraphy of prostatic cancer: preliminary results with ¹¹¹In-labelled monoclonal antibody 7E11-C5.3 (CYT-356). Prostate, 18:229-241.

38. Horoszewicz, J. S. U.S. Pat. No. 5,162,504

39. Wright, G. L. and Starling, J. J. U.S. Pat. No. 5,153,118.

40. Goldenberg, D. M., DeLand F. H., and Benett, S. J. 1983. Radioimmunodetection of prostatic cancer. In vivo use of radioactive antibodies against prostatic acid phosphatase for diagnosis and detection of prostatic cancer by nuclear imaging. J Amer Med Assoc 2:350-353

41. Wang, E. H., Freidman, P. N., and Prices, C. 1989. Cell 57:379-392.

42. Lamki, L. M., Buzdar, A. M. et al. 1991. Indium-111-labelled B72.3 monoclonal antibody in the detection and staging of breast cancer: a phase 1 study. J. Nucl. Med. 32:1326-1332.

43. Khaw, B. A., Bailes, J. ., Schieder, S. L., Lancaster, J., Powers, J., Strauss, H. W., Lasher, J. C., and McGuire, W. L. 1988. Human breast tumor imaging using ¹¹¹In labelled monoclonal antibody: athymic mouse model. Eur. J. Nucl. Med. V.14,p.362-366.

44. Colcher, D., P. Horan, Nuti, M. et al. 1981. A spectrum of monoclonal antibodies reactive with human mammary tumor cells. Proc. Natl. Acad. Sci. V 78, p. 3199-3203.

45. Rainsbury, R. M., Westwood, J. H., Coombes, R. C., Neville, A. M., McCready, V. R., and Gazet, J. C. 1983. Location of metastastic breast carcinoma by a monoclonal antibody chelate labelled with indium-111. Lancet V 1, p. 934-938.

46. Larson, S. M. 1981. Monoclonal antibodies for diagnosis and therapy. Univ. Wash. Med. V 8, p. 22-28.

47. Zalutsky, M. R. 1988. Antibody-mediated radiotherapy: future prospects. In: Antibodies in Radiodiagnosis and Therapy. CRC Press p.213-235.

48. Goldenberg, D. M. 1988. Targeting of cancer with radiolabelled antibodies. Arch. Pathol. Lab. Med. V 112 p. 580-587.

49. Elias, D. J., L. E. Kline, R. O. Dillman, R. M. Trim 1990. Treatment of human B-Lymphoma xenografts in nude mice with adriamycin-immunoconjugates prepared using an acid sensitive linker. Antibody Immunoconj. and Radiophrm. V 3, p.60.

50. Sivolapenko, C. Moreno, J. Corvalan, W. Smith, A. Ritter and A. Epenetos 1990. Redustion of the anti-mouse immunoglobulin response using a bispecific monoclonal antibody complexed to vinblastine. Antibody Immunoconj. and Radiophrm. V 3, p.61.

51. Hertel, A., Donnerstag, B., L. Schulte, A. Noujaim, et al. 1992. Therapeutic effects of anti-idiotypic HAMA after immunoscintigraphy in ovarian cancer patients. Eur. J. Nucl. Med., V. 19, p. 608

52. King, D. J., Mountain, J. R., Adair, R. J., Owens, R. J. et al. 1992. Tumor localization of engineered antibody fragments Antibody Immunoconj. and Radiophrm. V 5, p.159-170.

53. Colcher, D., Bird, R., Roselli, M., et al. 1990. In vivo tumor targeting of a recombinant single-chain antigen-binding protein. J. Nat. Cancer Inst. V. 82, p. 1191-1197.

54. Borrebaeck, C. A. 1992. Antibody Engineering: A practical guide. W. H. Freeman and Company.

55. Joiris, E., Bastin B., and Thornback, J. R. 1991. A new method for labelling of monoclonal antibodies and their fragments with ^(99m)Technetium. Nucl. Med. Biol. V. 18,p. 353-356.

56. Diamandis, EP, YU, H and Sutherland DJA. Detection of prostate specific antigen immunoreactivity in breast tumors. Breast Cancer Res Treat (in press) (1994).

57. Yu, H and Diamandis EP., Ultrasensitive Time-resolved immunof luometric assay of prostate specific antigen in serum and preliminary clinical studies. Clin. Chem. 1993; 99:2108-14.

58. Monne M, Croce C, Yu H, Diamandis EP. Molecular characterization of prostate-specific antigen in breast tissue. Unpublished data.

59. Hsu SM, Rains L, Fanger H. Use of avidin-biotin-peroxidase (ABC) in immunoperoxidase techniques. J. Histochem Cytochem 1981; 29:577-80.

60. Martin, E. W., Mojzisik, C. M., Hinkle, G. H eyt al, (1988) Radioimmunoguided surgery using monoclonal antibody, Am. J. Surgery 156:386-92.

Although preferred embodiments of the invention are described herein in detail, it will be understood by those skilled in the art that variations may be made thereto without departing from the spirit of the invention or the scope of the appended claims. 

What is claimed is:
 1. An in vivo method for treating endocrine cancer in non-prostatic tissue of a patient comprising: injecting the patient having endocrine cancer in non-prostatic tissue with biological binding units which bind to PSA produced by non-prostatic tissue of the patient.
 2. A method of claim 1, wherein the biological binding units are injected on a repeated basis to assist the development of antiidiotypic antibodies by the patient.
 3. A method of claim 1, wherein the biological binding unit is selected from the group consisting of antibodies, molecular recognition units and peptides.
 4. A method of claim 3, wherein the antibodies are selected from the group consisting of polyclonal antibodies, monoclonal antibodies, antibody fragments, antibody constructs, single chain antibodies and bifunctional antibodies.
 5. A method of claim 1, wherein the biological binding unit is conjugated with a toxic agent.
 6. A method of claim 5, wherein the toxic agent is a radioisotope.
 7. A method of claim 6 wherein the radioisotope is selected from the group consisting of ²²⁷Ac, ²¹¹At, ¹³¹Ba, ⁷⁷Br, ¹⁰⁹Cd, ⁵¹Cr, ⁶⁷Cu, ¹⁶⁵Dy, ¹⁵⁵Eu, ¹⁵³Gd, ¹⁹⁸Au, ¹⁶⁶Ho, ^(113m)In, ^(115m)In, ¹²³I, ¹²⁵I, ¹³¹I, ¹⁸⁹Ir, ¹⁹¹Ir, ¹⁹²Ir, ¹⁹⁴Ir, ⁵²Fe, ⁵⁵Fe, ⁵⁹Fe, ¹⁷⁷Lu, ¹⁰⁹Pd, ³²P, ²²⁶Ra, ¹⁸⁶Re, ¹⁸⁸Re, ¹⁵³Sm, ⁴⁶Sc, ⁴⁷Sc, ⁷²Se, ⁷⁵Se, ¹⁰⁵Ag, ⁸⁹Sr, ³⁵S, ¹⁷⁷Ta, ¹¹⁷mSn, ¹²¹Sn, ¹⁶⁶Yb, ¹⁶⁹Yb, ⁹⁰Y, ²¹²Bi, ¹¹⁹Sb, ¹⁹⁷Hg, ⁹⁷Ru, ¹⁰⁰Pd, ^(101m)Rh, and ²¹²Pb.
 8. A method of claim 7, wherein the radioisotope is selected from the group consisting of ¹³¹I, 125I, ¹²³I, ⁹⁰Y, ¹⁸⁶Re, ¹⁸⁸Re, ¹⁵³Sm, ⁷⁷Br, ²²⁷Ac, ²¹¹At, ¹³¹Ba, ⁷⁷Br, ³²P, ²¹²Bi, ¹⁶⁶Ho, ⁶⁷Cu, ⁴⁷Sc, and ²¹²Pb.
 9. A method of claim 5, wherein the toxic agent is a therapeutic drug.
 10. A method of claim 9, wherein the therapeutic drug is selected from the group consisting of Adriamycin, Chlororambucil, Daunorubicin, Leucovorin, Folinic acid, Methotrexate, Mitomycin C, Neocarzinostatin, Melphalan Vinblastine, Mitocyn, Mechlorethamine, Fluorouracil, Floxuridine, Idarubicin, Doxorubicin, Epirubicin, Cisplatin, Cannustine, Cyclophosphamide, Bleomycin, Vincristine and Cytarabine.
 11. A method of claim 5, wherein the toxic agent is a toxin.
 12. A method of claim 11, wherein the toxin is selected from the group consisting of diptheria toxin, ricin toxin, Monensin, Verrucarin A, Abrin, Vinca alkaloids, Tricothecenes, and Pseudomonas exotoxin A.
 13. A method in accordance with any one of the preceding claims, further comprising the initial step of injecting a patient with a steroid which induces the cancer cells to produce PSA, said cancer cells having receptors for the injected steroid.
 14. A method of claim 13, wherein the steroid is chosen from the classes of steroids selected from the group consisting of glucorticosteroids, mineralocorticosteroids, androgens, antiestrogens and progestin. 